Lake Sugar Tree Training Complex
Telephone (276) 650-1158
400 Movie Movers East
Axton, Virginia 24054
lakesugartree.com
[email protected]
Located at historic Lake Sugar Tree Motorsports Park
where “Stopwatches don’t lie”
Thank you for your interest in Lake Sugar Tree Training Complex. We look forward to your
attendance.
To confirm your space in the following training program: (check one)
___ Premium $1500 a month or ___ Basic $1200 a month or ___Weekly $475 a week
A deposit of $750 is required for the Premium Program, of $600 for the Basic Program and $250
for the Weekly Program. This deposit applies towards your Program rate of $1500 for the
Premium Program, or $1200 for the Basic Program or $475 for the Weekly Program, and the
deposit is NONREFUNDABLE.
Training Dates: Start Date: _____________
You may pay your deposit by cash, paypal, money order, or credit card. We accept VISA or
Mastercard. To pay by money order, please include your payment with the completed forms. To
pay by credit card, please either complete the enclosed credit card form and email it to
[email protected] or call our office and provide this information or fax to (434) 6853080.
The balance of the Program fee must be paid in full upon arrival. Thereafter, monthly program
fees are due on the 1st of the month each month for Premium Programs or Basic Programs, or
every Monday for Weekly Programs. Premium and Basic Programs are month- to-month, and
are automatically renewable with 30 days cancellation notice required to end your program.
Weekly Programs are week- to-week with no cancellation notice required.
To complete your enrollment, please complete the following enclosed Registration Form and
Release of Liability and return via mail to 400 Movie Movers East, Axton, Virginia or email to
[email protected] or fax to (434) 685-3080.
RELEASE OF LIABILITY and CONSENT FOR MEDICAL TREATMENT
I/We authorize _______________________________________________________
(Name of Student/Rider/Participant)
to attend, observe or participate in the Lake Sugar Tree Training Complex training program
(hereinafter at times referred to as “the Event”)
I/We hereby release, waive, discharge and covenant not to sue or assert any claim or cause
of action whether at law or in equity, whatsoever against Lake Sugar Tree Motorsports
Park, LLC or Lake Sugar Tree Motorsports Park, LLC, d/b/a Lake Sugar Tree Training
Complex, Bob Bailey, Carole Bailey, Melissa Smith, Ryan Smith or Gary Bailey, Diana Bailey
or its employees, its agents, its independent contractors, its representatives, its heirs, its
successors or its assigns, or against Ryan Smith MX Clinic, Gary Bailey Personal Coaching,
or any other entity owned, affiliated, managed, associated, or controlled by or with Lake
Sugar Tree Motorsports Park, LLC, Lake Sugar Tree Motorsports Park, LLC, d/b/a Lake
Sugar Tree Training Complex its heirs, representative, successors or assigns.
I/We also hereby agree to indemnify and hold harmless Lake Sugar Tree Motorsports Park,
LLC or Lake Sugar Tree Motorsports Park, LLC, d/b/a Lake Sugar Tree Training Complex,
Bob Bailey, Carole Bailey, Melissa Smith, Ryan Smith or Gary Bailey, Diana Bailey or its
employees, its agents, its independent contractors, its representatives, its heirs, its
successors or its assigns, or against Ryan Smith MX Clinic, Gary Bailey Personal Coaching,
or any other entity owned, affiliated, managed, associated, or controlled by or with Lake
Sugar Tree Motorsports Park, LLC, Lake Sugar Tree Motorsports Park, LLC, d/b/a Lake
Sugar Tree Training Complex its heirs, representative, successors or assigns.
Including, but not limited to any medic, EMT, promoter, sponsor, organization or property
owner connected with this Event in any manner, from any loss, liability, damage, cause of
action or cost that they may incur due to my/our presence at the training complex or Event
my participation in the training program or Event on the property where the training
program or Event is to occur at anytime including before, during or after the training
program or Event.
I/We acknowledge that the sport of Motocross, Supercross, Endurocross, Woods Riding,
Trail Riding, Cross Country and riding a motorcycle in an inherently dangerous activity and
I/We also assume full responsibility for bodily injury, death or property damage that may
occur to me, my minor child or children, or any member of my household, whether such is a
rider, participant or spectator as a result of my presence at or participation in the Training
Program or Event regardless of whether such bodily injury, death or damage is due to the
actions, omissions, negligence or gross negligence of Lake Sugar Tree Motorsports Park,
LLC or Lake Sugar Tree Motorsports Park, LLC, d/b/a Lake Sugar Tree Training Complex,
Bob Bailey, Carole Bailey, Melissa Smith, Ryan Smith or Gary Bailey, Diana Bailey or its
employees, its agents, its independent contractors, its representatives, its heirs, its
successors or its assigns, or against Ryan Smith MX Clinic, Gary Bailey Personal Coaching,
or any other entity owned, affiliated, managed, associated, or controlled by or with Lake
Sugar Tree Motorsports Park, LLC, Lake Sugar Tree Motorsports Park, LLC, d/b/a Lake
Sugar Tree Training Complex its heirs, representative, successors or assigns.
I/We acknowledge that I have been provided a copy of the Lake Sugar Tree Training
Complex rules of operation and that I/We and the rider/participant, or my child agrees to
follow the same. I/We further understand that failure to follow such rules may result in
immediate expulsion from Lake Sugar Tree Training Complex.
I/We understand that presence at or the participation in the Event exposes me, my
property, my child and any member of my household present whether as a rider,
participant or spectator to a RISK OF DANGER OR HARM and by being present at the Event
and by participating in the Event and relying on my and our own judgment and ability I/we
am and are accepting and assuming this risk.
I/We authorize Lake Sugar Tree Motorsports Park, LLC or Lake Sugar Tree Motorsports
Park, LLC, d/b/a Lake Sugar Tree Training Complex, Bob Bailey, Carole Bailey, Melissa
Smith, Ryan Smith or Gary Bailey, Diana Bailey or its employees, its agents, its independent
contractors, its representatives, its heirs, its successors or its assigns, or against Ryan Smith
MX Clinic, Gary Bailey Personal Coaching, or any other entity owned, affiliated, managed,
associated, or controlled by or with Lake Sugar Tree Motorsports Park, LLC, Lake Sugar
Tree Motorsports Park, LLC, d/b/a Lake Sugar Tree Training Complex its heirs,
representative, successors or assigns to have Participant medically treated should it
become necessary during the Event.
THIS IS A TWO PAGE RELEASE OF LEGAL RIGHTS. I HAVE BEEN GIVEN AND
HAVE READ BOTH PAGES.
BY SIGNING BELOW I REPRESENT THAT I HAVE READ AND UNDERSTAND
THIS RELEASE AND ACKNOWLEDGE THAT I AM SIGNING THE SAME
VOLUNTARILY.
___________________________________________
(Signature of Participant)
Date: __________________
___________________________________________
(If Participant is a minor, signature of parent)
Date: __________________
If Parents are divorced or do not share joint custody, then custodial parent must sign as
well:
___________________________________________
Date: __________________
(Signature of Custodial Parent, if applicable)
IF TEMPORARY GUARDIANSHIP OR POWER OF ATTORNEY BY PARENT IS
GIVEN TO ANYONE ACCOMPANYING A MINOR, THEN A COPY OF THE
GUARDIANSHIP OR POWER OF ATTORNEY MUST ACCOMPANY THIS RELEASE
AND GUARDIAN OR POWER OF ATTORNEY DESIGNEE MUST SIGN BELOW AS
WELL:
__________________________________________
Date: __________________
Guardian/Power of Attorney Designee
NOTARY PUBLIC:
City/County of ____________ State of _____________
Sworn to and subscribed before me this the ____ day of ___________, ______.
___________________________________________________
NOTARY
My commission expires: ____________________
REGISTRATION FORM
NAME: _____________________________________________________
AGE: __________ Date of Birth: __________________
BIKE SIZE(S) : _____________________________________________________
BIKE COLOR: ________________ NUMBER: __________
ADDRESS:
_____________________________________________________________________
CITY: ____________________________STATE: ____________ZIP CODE: _______
TELEPHONE: ________________________ CELL: ___________________________
EMAIL:
______________________________________________________________________
EMERGENCY CONTACT:
NAME: ______________________________________________________________
Relationship to Rider/Participant: ________________________________________
TELEPHONE (INCLUDING AREA CODE:__________________________________
Alternate Contact Number: _______________________________________
PLEASE LIST ANY MEDICATIONS RIDER/PARTICIPANT IS TAKING:
______________________________________________________________________
______________________________________________________________________
PLEASE LIST ANY ALLERGIES RIDER/PARTICIPANT HAS:
______________________________________________________________________
______________________________________________________________________
MEDICAL INSURANCE INFORMATION:
CARRIER: ___________________________________________
GROUP NUMBER:____________________________________
NAME OF INSURED ON CARD: _________________________________________
TELEPHONE NUMBER TO VERIFY COVERAGE: ___________________________
LAKE SUGAR MOTOR SPORTS PARK, LLC, d/b/a LAKE SUGAR TREE TRAINING
COMPLEX DOES NOT PROVIDE RIDER MEDICAL INSURANCE.
RIDER QUESTIONNAIRE
How many years riding? _______ years racing? ________
What thing do you want to learn about riding?
______________________________________________________________________
______________________________________________________________________
What do you find hardest to do now?
______________________________________________________________________
______________________________________________________________________
What, if any, are your plans, desires for racing?
______________________________________________________________________
______________________________________________________________________
CREDIT CARD INFORMATION
CARD TYPE:
_____ VISA
________ Mastercard
CARD NUMBER: _________________________________________________
EXPIRATION DATE: _________________________
THREE DIGIT CVC CODE (From back of card) _____________
BILLING ADDRESS FOR CARD:
______________________________________________________________________
______________________________________________________________________
ZIP CODE FOR BILLING ADDRESS FOR CARD: ______________________
LAKE SUGARTREE MOTOR SPORT PARK INFORMATION
Contact Number: (276) 650-1158
[email protected]
Website: lakesugartee.com
Physical Address for GPS: 400 MOVIE MOVERS EAST, Axton, Virginia 24054
Closest Airport: Greensboro, North Carolina (GSO) which is approximately 45
minutes away.
Closest town for hotel accommodations is Danville, Virginia or Martinsville,
Virginia.
LAKE SUGAR TREE TRAINING COMPLEX PROGRAM FEES:
Premium Package: $1500 a Month
Basic Package: $1200 a Month
Weekly Package: $475 a Month
PREMIUM PACKAGES with full hookups are available on a first-come, firstserved basis and must be reserved in advance by calling the contact number
above.
Facilities include heated and air conditioned showers, full bathrooms, dump
station, bike wash station, laundry facility and mechanic area.